As the expansion of Medicaid in Louisiana makes its tenuous way through the state Legislature, the city's top health official warned again on Wednesday that primary care and mental health services for the working poor could face serious cutbacks if lawmakers in Baton Rouge don't sign off on the bill.

The patchwork of New Orleans area clinics that have sprung up since Hurricane Katrina, created to fill the void left by Charity Hospital, have been running in part on temporary federal dollars that will go away next year and are counting on the Medicaid expansion envisioned by President Obama's federal healthcare overhaul to eventually kick in a provide a permanent source of funding.

Addressing the City Council's Health and Human Services Committee on Wednesday, New Orleans Health Commissioner Karen DeSalvo said it may be time to begin contemplating how to cope with the loss of money, given uncertain prospects either for an expansion of Medicaid or an extension of temporary funds that have been flowing to local clinics.

Karen DeSalvo

"I think we're reaching a point as a community where we have to start doing an accounting of what we're going to have to take away," DeSalvo said. "We have to really get ourselves focused on sorting out what we're going to do in January 2014."

DeSalvo and other local health officials have been trying for months to convince Republican Gov. Bobby Jindal and the Legislature to accept the Medicaid expansion, a central provision of the Affordable Care Act.

Plan B would involve extending a federal waiver, in place since 2010, that allows adults in Orleans, Jefferson, Plaquemines and St. Bernard Parishes who don't qualify for Medicaid to get primary and mental health services at nonprofit clinics. As things stand, DeSalvo said the waiver is helping to provide care for close to 60,000 people.

But to extend the waiver, Louisiana would have to put up matching funds of about 30 percent, DeSalvo said, where the federal government would pick up the whole tab under a statewide Medicaid expansion for the first three years. Eventually, the state would have pay as much as 10 percent of the cost of the new enrollees.

Eighty-five percent of patients covered under the waiver would qualify under the expansion, DeSalvo said.

Jindal has argued that Louisiana cannot afford an extension of the waiver, given the matching funds eventually required, and objects to a costly expansion of Medicaid while the federal debt continues to pile up. He also has criticized the Medicaid program as antiquated, saying the expansion envisioned by the federal law would push too many Louisianians into the government insurance program.

At the moment, there is one Medicaid expansion bill heading to the Senate floor. A bill drafted by Sen. Karen Carter Peterson, as amended by Sen. Ben Nevers, D-Bogalusa, passed out of a state Senate committee on Tuesday that would use federal money to help the uninsured in Louisiana buy private insurance.

But as the House health committee earlier killed a proposal to expand Medicaid -- and Jindal would likely veto any legislation that did make it all the way through the process -- the odds of a measure becoming law appear slim.

Still, City Councilwoman Susan Guidry called the committee's approval -- which passed by a single vote -- a "ray of hope," noting that she has already been to Baton Rouge to push for the expansion. She told DeSalvo that she would be happy to collaborate on the lobbying effort, or would even "go up there and chain myself to something" if need be.